Healthcare Provider Details

I. General information

NPI: 1871985127
Provider Name (Legal Business Name): ULSTER CORRECTIONAL FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BERME RD
NAPANOCH NY
12458-2709
US

IV. Provider business mailing address

750 BERME RD PO BOX 800
NAPANOCH NY
12458-2709
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-1670
  • Fax:
Mailing address:
  • Phone: 845-647-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008434
License Number StateNY

VIII. Authorized Official

Name: CHERIF MAKRAM
Title or Position: HEALTH SERVISE DIRECTOR
Credential: MD
Phone: 845-647-1670